Please send an acknowledgement to the individual or organization to whom I am dedicating my donation.







    I want my donation to be listed as:
    In Memory OfHonoring




    Name of person in whose MEMORY donation is being made:

    Names of persons being notified:

    Address:

    Phone no. or email address: (optional)

    If you need additional people notified - use this space:



    OR


    Name of person in whose HONOR donation is being made:

    Names of persons being notified:

    Address:

    Phone # or email address (optional)

    If you need additional people notified - use this space:



    Donor's name:

    Donor's address:

    Donor's phone and/or email:

    Donation amount
    $


    Your message to this special person or family ....